Process for the production and maintenance of general analgesia or anesthesia.



n. E.JACKSON. V PROCESS FOR THE PRODUCTION AND MAINTENANCE OF GENERAL ANALGESIA AND ANAESI'HESIA.

APPLICATION FILED AUG. I9. I915.

Patented 001]. 24, 1916.

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D. E. JACKSON. PROCESS FOR THE PRODUCTION AND MAINTENANCE or GENERAL ANALGESIA AND AN/ESTHESIA.

APPLICATION FILED AUGJQ, I915- Patented O't. 24,1916.

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DENNIS EMERSON JACKSON, OF ST. LOUIS, MISSOURI.

PROCESS FOR THE PRODUCTION AND MAINTENANCE OF GENERAL ANALGESIA OR ANESTI-IESIA.

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Specification of Letters Patent.

Patented Oct. 24L, 1916.

Application filed August 19, 1915. Serial No. 46,319.

To all whom it may concern:

Be it known that I, DENNIS EMERSON JACKSON, a citizen of the United States, residing at Scott and Euclid avenues, in the city of St. Louis, in the State of Missouri, have invented a new and useful Process for the Production and Maintenance of General Analgesia or Anesthesia, (depending on the pharmacological properties of the anesthetic substance used.)

My invention relates to the production and maintenance of general analgesia or anesthesia by means of a continuous process of rebreathing of gaseous or volatilized a11- esthetic substances, which are added to the respiratory medium supplied to the person treated, and from which the organic poisons, bacteria, excess of watery vapor, carbon dioxid, etc., exhaled by the person are continuously removed or destroyed by washing through dehydrating and sterilizing substances, such as concentrated sulfuric acid, and from which the carbon dioxid is removed by washing through such substances as strong aqueous solutions of sodium hydroxid, calcium hydroxid, potassium hydroxid or barium hydroxid, and to which oxygen is constantly added in proportions suitable to maintain the patient in a satisfactory condition.

This process for the production and maintenance of general analgesia or anesthesia is put into effect by, and is involved in, the action of the apparatus hereinafter to be described.

The process and its method of application can best be illustrated by reference to the following drawings, in which- Figure 1 is a general plan of the apparatus exclusive of the face piece and breathing bag which are represented in Figs. 2 and 8, of which Fig. 2 is a lateral view and Fig. 3 is an edgewise view. Figs. A, 5 and 6 represent on an enlarged scale the wash jars shown at 9 and 25 in Fig. 1. Fig. 7 is an elevation of the apparatus as seen from in front, and Fig. 8 shows on the same scale the method of attachment of the face piece and breathing bag to the apparatus by means of two (interrupted) pieces of rubber tubing. Fig. 9, which is one half natural size, shows the face-piece, breathing bag and communicating rubber tubes as viewed from the right and slightly from above.

In Figs. 1, 2, 3 and 9 the direction of the air current is indicated by the direction of the arrows.

Similar numbers refer to similar parts throughout the several views.

The explanation may be expedited by referring first to Fig. 7 which is an elevation of the apparatus as viewed from in front. From this it will be seen that the apparatus consists of a square table framed of iron, 16 inches square at the bottom, 37 inches high and the wood top of which is 1 1 inches square. At a distance of about 5 inches from the floor is placed a wooden shelf on which is fastened a small electric motor 1, used to actuate an air pump and from which a belt passes upward to the pump 2, which is placed on top of the table. This pump may be of the rotary form as shown here, or of the piston form, or of any other form which is capable of maintaining in constant circulation within a closed system of tubes and vessels, a given volume of air or other gaseous medium without loss from within or gain from without. But the invention of any particular form of pump for this purpose is no part of my present application' and no claim therefor is made.

Referring now from Fig. 7 to Fig 1 we may see in the plan of the apparatus the general relations of the motor 1, to the pump 2, and the connection of the latter with a closed system of pipes and vessels within which the pump can cause to circulate continuously either air, or gas, or certain forms of vapor. Air Or other gaseous medium entering the pump through pipe 32, will be carried around inside the pump and forced out at pipe 3. If at this time valve 1 be partially or wholly open then part or all of the air or vapor leaving the pump may pass out of the valve into the surrounding atmos phere. But if valve 4: be closed then the air leaving the pump passes forward through valve 5 and pipe 7 into the jar 9. In the lower part of this jar is placed a strong aqueous solution of the hydrates of sodium and calcium (or of other alkaline hydroxids) the purpose of which is to absorb the carbon dioxid exhaled by the patient and toserve as a medium of purification for the anesthetic gas or vapor being used. The water of this solution also serves to moisten the respiratory medium before it passes on to the patient.

The air or vapor passing from pipe 7 into the jar 9 is made to pass through a special form of apparatus within the jar. This apparatus, which can-best be understood by reference to Figs. 4, 5 and 6 (which are enlarged drawings of the parts represented in 8,9, 24 and 25 of Fig. 1) has for its object the prevention of splashing upward of the fluid within the jar, thereby preventing any spray from the fluid from leaving the jar and passing onward to the patient. Air entering the jar from pipe 7 passes down through a 'short piece of rubber tubing which connects pipe 7 to the part shown in Fig. 5 which is made of glass. Air passing down inside the tube here shown is liberated into the solution at the bottom of the tube. Much splashing of the solution is hereby produced but this splashing is almost wholly confined withinthe glass cylinder which is attached to the glasstube by four glass spokes, two above and two below. All fluid which splashes upward within the cylinder is caught by the overhanging bell of glass and directed back down into the solution. The air, which also passes upward into the bell, turns downward and passes out below the bell but above the surface of the subjacent fluid. Thence the air passes upward, free from all spray, and leaves the jar by way of pipe 10 (Fig. l). The cover of the jar (Fig. 4) is'held on air-tight by means of nuts screwed on to the ends of rods which pass upward from the metal receptacle holding the jar (Fig. 7) and pass through holes in the lid where it extends outward beyond the edge of the jar.

' be passed into this reservoir.

From pipe 10 (Fig. 1) the air enters a small glass reservoir 12. This reservoir serves a. number of purposes. Being of glass it enables the operator to see at a glance if any solution, dust, etc., is being passed fromthe machine to the patient. It thus serves as a safety device. In it may alsobe placed water to further moisten the air breathed by the patient if this should be found necessary in any given case. Carbon dioxid, or ether, or any other gaseous or olatile or vaporized substance which it may be desired to administer to the patient may Or odorous substances, such. asthe. oil of bitter orange peel, may be placed in the reservoir to perfume the air breathed by the patient and thus help to conceal the unpleasant effects of such substances as ether, etc.

From the reservoir 12 (Fig. 1) the air passes out through'pipe 13 (Figs. 1 and 9) which connects with a piece of rubber tubing. (32 in Fig. 9) three-eighths of an inch in inside diameter and three or four feet long. This tube passes to the face piece to which it is attached through the brass tube 19 (Figs. 2, 3, 8 and 9). The tube 19 is secured to a flange 0 which extends from a short metal cylinder as shown most clearly .is firmly soldered.

in Fig. 9. The upper surface of this cylinder is covered by a metal plate to which it In the center of this plate is a large round hole into which a flange (c in Fig. 9) is soldered. The flange is about one and one-half inches in diameter and extends about three-fourths of an inch above the surface of the plate. Over this flange the neck of the rubber breathing bag 16 is placed, the connection being airtight, while the bag itself extends above. The tube 19 passes inward to near the center of the flattened metal cylinder 1%, then the tube 19, by means of a right angled joint (f in Fig. 9), turns upward, becoming tube 15 (Figs. 2, 3, 8 and 9) which carries the incoming air (and anesthetic) far up near the top of the surrounding bag 16. Side by side and parallel with tube 19 (Figs. 2, 8 and 9) is tube 17 (Figs. 2 and S). \Vhile it is the purpose of tube 19 to carry air into the bag and liberate it high up and away from the neck of the bag, it is the purpose of tube 17 to carry the air away from the bag, and it accomplishes this by draining away the air from low down within the neck of the bag where it is attached 011 to the metal flange. Thus, so long as the pump is running, a th0rough and complete ventilation of the air within the bag is secured. \Vithin the flattened metal cylinder l-zl (Figs. 2, 3, 8 and 9) is placed a hinged valve 20 (Figs. 2 and 9), which acts like a door and whose raising or lowering will open or close the outlet (a in Fig. 9) of the metal cylinder 11 at the bottom. This valve is operated by a small curved handle (cl in Fig. 9) which projects just to the left of the cylinder 14 (Figs. 2 and 9). This valve is used to close off the bag from the external air when it is necessary to remove the face piece from the face, as for example, when the patient vomits. If the valve be closed before the bag is removed none of the anesthetic vapor will escape from within the apparatus.

To the lower surface of the cylinder ll, and opening into it by a large oval opening (a, Fig. 9%, is attached a piece, 18, of meta, celluloic or rubber which is shaped like the surface of a frustum of a cone which has been flattened from side to side. To the lower edge of this piece is attached a rubber pneumatic cushion (c, Fig. 9) which fits air-tight to the face of the patient. I disclaim the invention of this rubber cushion, of which many forms have already been made. In the right-hand side of the coneshaped piece .18, and a little distance below the edge of the cylinder 14.- (Figs. 2. 8 and 9), is made a round opening (it, Fig. 9) about three-fourths of an inch in diameter. It is the purpose of this hole to admit a tube from the outside into the cavity of the coneshaped piece 18. Through this tube air and anesthetic vapor may be passed from the apparatus into a catheter which is used for intra-tracheal insufilation. When intratracheal insufliation is not being used then the round opening (h, Fig. 9) in the coneshaped piece 18, is closed by means of a rubber stopper and the patient breathes freely back and forth through the face piece and into and out of the bag. Vith reference to intra-tracheal insuffiation I claim only that my apparatus is so constructed that it may be readily used for this form of anesthesia if the operator so desires.

The breathing bag is large, of approximately-twice the vital capacity of the patient, and is made of thin and very flexible rubber. Passing up inside of it is the metal tube 15 (Fig. 2) which terminates about two-thirds of the distance upward from the neck to the top of the bag. Near this termination two holes are made in the sides of the tube to further insure ventilation if the end of the tube becomes closed. Projecting upward in the shape of a horseshoe and attached by each end to the sides of the top of the tube 15, is a spring (g, Fig. 9) made of coiled steel wire. This spring furnishes a flexible support which maintains the bag in a perpendicular position from the face of the patient.

I am aware that rubber bags have been used in connection with various forms of anesthetic inhalers heretofore. But I am not aware that a bag of such large dimensions arranged in connection with such a face piece and internal flexible support as that herein provided, and arranged for a continuous thorough internal ventilation by the respiratory medium, and for a continous repurification of the anesthetic gas or vapor breathed from the bag, has ever before been invented or used.

In Fig. 9, the rubber tube 39, when produced to the face-piece, connects by means of its opening is, with the inlet tube 19. Similarly the tube 0, when produced, connects by the opening j, with the outlet tube 17. The valve 20, is hinged as at Z), and is oper ated by the short lever (Z. When (Z is raised and turned toward the left, the valve 20 is opened, and when cl is turned toward the right and lowered, the valve closes the opening a. When the face-piece is in use the patient breathes back and forth through the piece 18, by way of the oval opening a, into the cylinder 14, through the flange 0, around the tube 15, and thus into and out of the bag 16. It will thus be seen that the breathing of the patient into and out of the facepiece and breathing bag is wholly free and independent of the circulating air system maintained through the bag by the pump and its communicating tubes and vessels. It is the function of valve 20 to retain within the breathing bag, the pump and their associated system of tubes and vessels, any anesthetic gas or vapor or any free oxygen which may be contained therein when the facepiece is removed from the patient.

From the face piece air passes out through tube 17 (Figs. 2, 8 and 9), and, through a rubber tube (0, Fig. 9) of three-eighths inch inside diameter and three or four feet long, it again reaches the apparatus through pipe 21 (Figs. 1 and 9). The two rubber tubes (0 and p, Fig. 9) which connect the-face piece and bag with the apparatus are held together side by side, by means of small, fiat, metal clamps (Z, m, n, in Fig. 9). At 22 (Figs. 1 and 9) is placed a check valw e to prevent reversal of the air current which proceeds through pipe 23 (Fig. 1) to the wash jar 25 where the air passes through concentrated sulfuric acid which absorbs the excess of watery vapor exhaled by the pa tient and sterilizes the air. In the jar 25 is placed a gas washing apparatus exactly similar to that above described in connection with Figs. 4, 5 and 6 and with numbers 8 and 9 in Fig. 1. From the jar 25 the air passes by pipe 26 through valve 34 back to the pump which it reaches by pipe 32. Just above pipe 32 is valve 33 which opens to the outside. If, while the pump is running, this valve be opened a little air immediately enters the system and expands the breathing bag. But this excess air can be eliminated immediately by opening valve 4. These valves 33 and 4 give complete command of the volume of air or anesthetic vapor which the operator desires to circulate in the apparatus. Through the pump and this closed system of pipes and vessels air or gas or vapor may be kept in continuous circulation. But the patient breathing into and out of the bag will constantly add watery vapor and carbon dioxid to the respiratory medium and extract oxygen therefrom. The watery vapor and carbon dioXid are absorbed by the sulfuric acid and alkaline hydroxid solution respectively. The oxygen loss, however, is again made good by injecting oxygen from the tank 35 (Figs. 1 and 7) into the air system. From the tank 35 a tube 37 leads down into a wash bottle 39, containing a solution of sodium bicarbonate through which the oxygen is washed. From.

the top of this bottle a tube 40, leads to the air-cock 6, through which the oxygen is i11- jected into the air system according to the needs of the patient.

For nitrous oxid analgesia or anesthesia. a tank of nitrous oxid 36, (Figs. 1 and 7) supplies the gas which passes by tube 38, to the wash bottle 39, and thence by tube 40 t0 air-cock 6, through which it enters the air system. It will be seen from the general principles here involved that when suflicient nitrous oxid has been injected to fully anesthetize the patient, then no more nitrous oxid need be injected throughout the course is the best of all known anesthetics, is thus greatly reduced, and thedegree of the anes thesia will. be'much more'regular and con stant than .that produced by the. use of any otherjform of apparatus. For so long as no airis allowed to enter the system from without, and none is allowed to escape from within,.the; saturation of the air in the system and; consequently of the tissues and central nervous system of the patient will remain constant and the depth ofthe anesthesia will also remain constant. The onlyvariation which may arise here is in making too great a variation in the rate of supply of oxygen to the patient. This supply should be kept perfectly constant and regular. By stopping the pump any amount of rebreathing, andof carbon dioXid accumulation in the bag, which the operator may desire is readily secured. And during this time the oxygen supply to the patient is wholly independent of the rebreathing, of the carbon dioxid, and of the anesthetic gas. And the operator has complete command of all these featuresat all times. These same general principles apply to the use of ether, chloroform, ethyl chlorid, ethyl bromid, etc. For

the administration of fluid anesthetics a burette 31 (Figs. 1 and 7) is used. From this the solution, 6. g. ether, is injected in small repeated doses through a tube 29, by way of the air-cock 30, into the air system. Only small amounts of these anesthetics are needed and when the patient is once fully anesthetized no further anesthetic need be given. Very volatile bodies, such as ethyl chlorid, are best sprayed into the apparatus through a short piece of rubber tubing 27, attached to the air-cock 28. By a fortunate coincidence sulfuric acid and sodium hydrate solution are the two most common reagents used in thepurification of the anesthetics now in general use. And in thisapparatus the anesthetic is constantly purified over and over. And such very volatile substances as ethyl chlorid, which, although capable of being. of great use and benefit in medicine,

have been practically prohibited heretofore on account of the cost of the large quantities needed for-prolonged anesthesia, and from lack of any satisfactory method of administration, may be readily used in this apparatus.

The respired air or anesthetic gas or vapor is automatically warmed in this apparatus. This is accomplished first by the heat generated by the sulfuric acid in the absorption of watery vapor, and second by the pump which generates heat not only from its friction in turning but also in the compression .of the air passed through it. In rebreathing When the pump is not running the patient himself quickly warms the air in the bag.

I am aware'that various forms of apparatus for the administration of anesthetics have been made heretofore, but I am not aware that any such apparatus as this herein described, involving the same principles, operated in the same manner, and producing the same results according to the various processes herein described, has ever before been invented or used.

While I have, for the purpose of enabling others to readily carry out my method, pointed out the dimensions of various parts of the appa atus and specifically described the materials of which said parts may be made, it is to be understood that the invention is not in any way limited to a structure of this kind, for any suitable apparatus may be used in following the new method set forth in the claims.

I claim:

1. The method of producing and maintaining general analgesia or anesthesia, which comprises circulating an anesthetic fluid with the respiratory fluid to and from the patient, thereby reusing the anesthetic fluid continuously, at the same time removing carbon dioXid, watery vapor and organic substances from the circulating fluids.

2. The method of producing and maintaining general analgesia or anesthesia, which comprises circulating an anesthetic fluid with the respiratory fluid to and from the patient, thereby reusing the anesthetic fluid continuously, at the same time forcing the circulating fluid through an alkaline hydroxid and through a dehydrating agent so as to continuously repurify the anesthetic fluid, absorb watery vapor and remove car-- bon dioxid.

3. The method of producing and maintaining genera-l analgesia or anesthesia which comprises introducing a mixture of fluids, including an anesthetic fluid, into a continuous fluid conductor having a mouthpiece, closing the continuous fluid conductor to confine the anesthetic fluid, circulating the confined anesthetic fluid artificially and controlling the circulation thereof without admitting fluid into said conductor, thereby circulating the confined anesthetic fluid continuously to and from the mouthpiece and throughout the closed conductor, so as to reuse the confined anesthetic fluid continuously, and adding oxygen to the circulating anesthetic fluid.

4. The method of producing and maintaining general analgesia or anesthesia which comprises confining a mixture of fluids, including an anesthetic fluid, in a continuous fluid conductor having a mouthpiece, circulating the confined anesthetic fluid artificially and controlling the circulation thereof Without admitting fluid into said conductor, thereby circulating the confined anesthetic fluid continuously to and from the mouth piece and throughout the closed conductor, so as to reuse the confined anesthetic fluid continuously, and at the same time continuously repurifying the circulating anesthetic fluid, and adding the oxygen to the circulating anesthetic fluid.

5. The method of producing and maintaining general analgesia or anesthesia which comprises confining a mixture of fluids, including an anesthetic fluid, in a continuous fluid conductor having a mouth piece, circulating the confined anesthetic fluid artificially and controlling the circulation thereof Without admitting fluid into said conductor, thereby circulating the confined anesthetic fluid continuously to and from the mouthpiece and throughout the closed conductor, so as to reuse the confined anesthetic fluid continuously, and at the same time forcing the circulating anesthetic fluid through an alkaline hydroxid and dehydrating agent so as to continuously repurify the anesthetic fluid, absorb Watery vapor and remove carbon dioxid therefrom, and adding oxygen to the circulating anesthetic fluid.

DENNIS EMERSON JACKSON.

\Vitnesses LORETTA K; OGORMAN, J 01m HIGGINS.

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